| NPI | 1952189185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP1600X Counselor Pastoral (Licence: FL 22139) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL 22139) |
| Enumeration Date | 2023-09-19 |
| Last Update Date | 2023-09-19 |